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The role of the health care professional is critical to the success of organ and tissue donation. Nurses, physicians and other health care professionals are the vital link between the New York Organ Donor Network and organ and tissue donors. It is this partnership that ensures that families of potential donors are given the opportunity to make informed decisions about donation.
The Donor Network's Hospital Services Department has an assigned liaison for every hospital (there are a total of nine transplant centers and more than 100 hospitals) in its service area, the Greater New York metropolitan area. So there is always someone to help develop a hospital's organ and tissue donation practices. We also offer programs throughout the year for continuing education credit. The Donor Network's Hospital Services Department can assist you with questions regarding the donor process, compliance with state laws and federal regulations, hospital policies and procedures, and educational opportunities.
In those cases in which families are asked to consent to both the organs and tissues of their loved ones, hospital staff will work closely with the Donor Network's Clinical Department. This applies to cases in which the potential donor has been declared brain dead.
When a patient has suffered cardiac death, hospital staff will deal (generally, on the telephone) with the Donor Network's Tissue Services Department.
The following will help you identify potential donors: |
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| ORGAN DONORS |
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TISSUE DONORS |
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| Present or pending declaration of brain death |
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All cardiac deaths |
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| Mechanical ventilation and intact cardiovascular system |
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| In certain circumstances, there is another donation option to offer families, namely, Donation After Cardiac Death (DCD). From our On the Beat publication (Winter-Spring 2003), click here to read more about Donation After Cardiac Death. |
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| The Donor Network's Role in the Organ Donation Process |
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| Organ Donation Process |
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Health Care Professionals' Role in Organ Donation
This section concentrates on those cases where a patient is declared brain dead. Under these circumstances, next of kin are asked to consent to both organ and tissue donation. This is the process that is described here. |
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| When a patient suffers cardiac death, only tissues can be requested, and the role of the health care professional under these circumstances is explained further down in this section. |
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Q: Why does every death have to be reported to the New York Organ Donor Network?
A: There is still a critical shortage of organs in the U.S. Every day, approximately 17 Americans die waiting for a donated organ. A single donor can save many lives and improve the lives of countless others through corneal, skin, bone and other tissue transplants. In August 1998, the Center for Medicare and Medicaid Services (CMS) Conditions of Participation Section 482.45 (a) came into effect, requiring hospitals to call in all deaths or imminent deaths to the organ procurement organization for evaluation for organ and tissue donation. For complete information on the CMS Conditions of Participation and Questions and Answers for hospitals, please go to http://cms.hhs.gov/cop/2a2.asp. |
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Q: How do I make a referral?
A: Call the New York Organ Donor Network at 1 (800) Gift 4 NY. We're here 24 hours a day. We will ask a few preliminary questions to determine the initial suitability of the patient for organ and tissue donation. |
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Q: What determines brain death?
A: Death by neurological criteria - brain death - is the total, irreversible cessation of all brain functions, including the brain stem. Brain death is an established medical and legal principle, approved by the American Medical Association and the American Bar Association. A brain dead patient exhibits no purposeful response to pain, no spontaneous movements, no brain stem reflexes and no spontaneous respiration.
Organ donation can only occur if the organs of a brain dead patient are kept viable through mechanical ventilation and vascular support. Under New York State law, two licensed physicians who are not affiliated with organ/tissue recovery or transplant teams must determine brain death. For a more complete definition, click here: Brain Death. |
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Q: What should be done if brain death is imminent?
A: Call the New York Organ Donor Network at 1 (800) Gift 4 NY. A Donor Network representative will come to the hospital to further evaluate the patient's suitability for organ donation. Once suitability is determined, they will work closely with the health care team through every step of the donation process. |
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Q: How should consent for donation be handled?
A: The CMS Conditions of Participation require the person asking a patient's next of kin for consent to be a representative of a federally designated organ procurement organization, eye bank, tissue bank, or a designated requestor. The shock of losing a loved one, confronting the difficult concept of brain death, and making a choice about organ donation are dealt with in a small window of time. The Donor Network representatives are well versed in the sensitive steps necessary to guide a family through this process. We know that people are more likely to donate when brain death is explained, discussed and accepted before the opportunity of donation is offered. |
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Q: What is the role of the doctor or nurse?
A: Families come to rely on the comforting presence of the doctors and nurses who cared for their loved ones. Therefore, your familiarity with the donation process will enable families to make an informed decision. A Donor Network representative will work with the hospital staff to approach a patient's next of kin to assure that they understand brain death and have accepted the grave prognosis before donation is mentioned. National studies have shown that consent for donation is more likely when it is requested from an organ procurement organization and supported by the hospital staff. |
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Q: What is the procedure for organ recovery?
A: Organs are recovered in the OR while the donor is maintained artificially on a ventilator. |
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Q: What happens to the donor's family after they consent?
A: The Donor Network provides ongoing care and support for the families of those who have given the gift of life to others through donation. If a family wishes to become part of our Donor Family Services/AfterCare program, they may receive general information as to where and to whom their loved one's organ has been placed. The Donor Network facilitates the exchange of mail between donor families and recipients, while preserving the confidentiality of each. Over the course of a year, Donor Network representatives reach out to donor families with letters, telephone calls and gatherings. Our long-term AfterCare Program is a comforting support that grieving families can rely upon. After one year, donor families may volunteer their time to the Donor Network by sharing their experiences and acting as a mentor for other donor families. |
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Q: What are the things families most want to know?
A: While a signed donor card or other directive may be legally binding, in practice, consent for the donation is sought from a patient's next of kin. If it is determined that a person had enrolled in the New York State Organ and Tissue Donor Registry, indicating a prior intent to be a donor, this information will be shared with the next of kin, as they decide whether to permit donation. |
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Q: Which Tissues Can be Transplanted?
A: Human allograft tissue is the name given to anatomical material donated by deceased donors. Allograft tissue enhances the lives of recipients and sometimes saves lives. These groups of tissues may be transplanted:
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| Cardiovascular Tissue |
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Human heart valves, thoracic aorta, abdominal aorta with iliac arteries, saphenous veins, femoral vessels |
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| Integumentary Tissue |
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Skin |
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| Musculoskeletal Tissue |
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Bone, ligaments |
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| Ocular Tissue |
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Cornea, sclera, and whole eye |
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| Cells from Organs |
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Example, pancreatic cells, hepatic cells |
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| The Donor Network's Role in the Tissue Donation Process |
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| Tissue Donation Process |
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Health Care Professionals' Role in Tissue Donation
Tissue donation may be as meaningful for a donor family as for the transplant recipients. But tissue donation only happens with the collaborative effort of all health care professionals involved with the potential donor.
By law, physicians, nurses and support staff have to inform the New York Organ Donor Network of every hospital death in the Greater New York metropolitan area. These take place 24 hours a day, seven days a week.
Refer every potential donor to the Donor Network as soon as possible after cardiac death. Due to the limited time involved in making this gift happen, a timely referral is crucial. Indeed, a referral of a tissue donor should take place immediately after death. Recovery generally takes place within 24 hours.
By referring every potential donor, you ensure the family's right to make a decision about donation. This allows the Donor Network time to evaluate the donor for suitability, support the family, and provide the family with information to make an informed decision about donation.
Ask questions if you're unsure. The Donor Network's mission includes increasing awareness and fostering understanding of tissue donation among health professionals, including the following: |
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Physicians and nurses who are involved in the care of the patient and the family use clinical expertise to evaluate patients. The Donor Network's Consent Coordinators contact these primary care givers for this clinical information that helps to determine if the patient can donate tissues and which tissues can be donated. |
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Admitting personnel provide demographic information that includes the patient's date of birth, admission information, admitting diagnosis, and information about the legal next of kin. Generally, admitting personnel assist in the completion of the death certificate and may be the primary contact for the Medical Examiner or funeral directors. Admitting personnel may serve as the bridge between the coordinators and other parties involved in transporting the potential donor to an autopsy or funeral home. |
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Laboratory and Ancillary Department personnel such as radiologists and the blood banks provide results of any exams the potential donor may have had during this admission. The Consent Coordinators gather this data, which is critical to determining if the patient can be a donor. |
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Operating Room staff work with the Donor Network's specially trained Tissue Recovery staff to secure operating room space for the recovery to take place and provide support for the procurement process. |
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Hospital support staff, including unit clerks, security personnel, and morgue attendants assist the Consent Coordinators and Tissue Recovery staff, providing valuable assistance in securing the donor for recovery. |
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